Diabetes (Diabetic Nephropathy)

Diabetes is the leading cause of kidney failure in the United States. According to the American Diabetes Association, 23.6 million Americans have diabetes and, unfortunately, about 5.7 million (almost one quarter) do not know they have the disease. Diabetes affects the body’s ability to control the amount of blood sugar (blood glucose) in the body to be used for energy. Diabetes is a major risk factor for kidney disease because it damages the blood vessels and filtering units (glomeruli) of the kidneys. Over time, this damage prevents the kidneys from effectively filtering the bloodstream for wastes. About one-third of people who have had Type 1 (juvenile) diabetes for at least 20 years are at risk for Diabetic Kidney Disease. About 10 to 40 percent of Type 2 (adult onset) diabetics also have kidney disease. Diabetes can also cause high blood pressure and hardening of the arteries (called arteriosclerosis). This can lead to heart and blood vessel disease.

What are the symptoms of Diabetic Nephropathy?

The first signs of Diabetic Kidney Disease is often the presence of small amounts of protein in the urine or elevated levels of creatinine in the blood, which is the waste product removed from the body by the kidneys, found within the blood. Unfortunately, early symptoms of the disease are often not recognized until the kidneys have lost much of their ability to function. If you have one or more of these symptoms, you should consult your physician:

Morning facial puffiness

Visible blood in your urine (aka hematuria)

Urinating less frequently than usual

How is Diabetic Nephropathy diagnosed?

The most common way to determine kidney disease is by using your blood creatinine to estimate your Glomerular Filtration Rate (GFR). The GFR is the measure of the kidneys' ability to filter and remove waste. The American Diabetes Association (ADA) and the National Institutes of Health (NIH) recommend that eGFR be calculated from serum creatinine at least once a year in all people with diabetes. General protocol for diabetics is usually an annual spot (random) urine screening of your albumin to creatinine ratio (ACR) to detect microalbuminuria (a sensitive measurement of urine protein).

How is Diabetic Nephropathy treated?

Diabetic Nephropathy is treated in the following ways:

Medications prohibiting the narrowing of blood vessels

Strict monitoring of blood sugar levels

Keeping blood pressure below 130/80 mmHg

Controlling diet and dietary counseling (Medicare will pay for nutrition counseling for CKD)

Ongoing primary care and referral to a nephrologist for an early opinion

Prevention of Diabetic Nephropathy

The best way to prevent getting kidney disease from diabetes is to:

Control blood sugar level

Control and monitor blood pressure, having it checked several times per year

Get tested for kidney disease at least annually (measure your eGFR and ACR at least once a year to detect kidney disease and monitor how well your kidneys are working)

If your doctor prescribes them, take medicines to control your blood glucose, cholesterol, and blood pressure

Follow your diet for diabetes as prescribed by your physician or dietitian